Food Security and Nutritional Indicators for Needs Assessment – Collating Information Firdousi Naher International Food Policy Research Institute T RAINING

Food Security and Nutritional Indicators for Needs Assessment – Collating Information

Firdousi Naher International Food Policy Research Institute

TRAINING COURSE ON:

ASSESSMENT OF NUTRITIONAL STATUS

18-22 DECEMBER 2011

DHAKA

INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE

Four decades of remarkable growth

• Poverty declined from 75% in 1971 to 31.5% in 2010

• Between 2005-2010 GDP per capita grew at 6.19%

• Appreciable reduction in non-income welfare indicators:population growth rates have halved lowered infant and child mortality expanded immunisation coverageimproved water and sanitationaugmented life expectancyincreased net primary enrolment ratioeliminated gender gap in schooling

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Similar developments in the food economy

• Dramatic increase in rice production leading to closing the gap between rice availability and rice requirement

• In the past decade, 84% of the increase in production has been brought about through increased yield; 16% through area expansion

• Broadened consumption basket

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Trends in maternal and child under-nutrition

Page 4


Slow spread of these developments into nutrition

Page 5

Prevalence of maternal and child undernutrition

Childhood anemia (HKI, NSP 2006)

Anthropometric indicators (BDHS 2007)

05

101520253035404550

Anthropometric indicators

Stunting

Underweight

Wasting

Women with low BMIWomen <145 cms tall

0102030405060708090

100

Child age groups

6-11 mo

12-23 mo

24-35 mo

35-47 mo

48-59 mo


Why has nutrition eluded the progress in food, agriculture and health?

• Certain expectations of policy makers often leave nutrition out of lead policy

• Stagnated consumption patterns • Achieving food security through focus on both input and

output market have not always complemented each other• Need for strong of institutional arrangements for

coordination• Need for greater priority in nutrition initiatives• Need to strengthen development administration• Need for more gender sensitive policies aimed at greater

empowerment of women• Greater awareness needed on dietary diversity

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3 Types of Food and Nutrition Insecurity

• First, there are those chronically food-insecure – about 28 million Bangladeshis – who cannot purchase enough rice or wheat to meet energy requirements.

• Second, those who normally meet energy requirements, but run the very real risk of loosing access to food – due to shocks – are also food insecure.

• Third, a large percentage of the population is food-insecure due to diet quality rather than diet quantity.

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What is nutritional assessment?

• Measurements of body size, body composition or body function to diagnose nutrient deficiency or deficiencies

• Measures derived from nutritional assessments may be viewed as biological manifestation of nutrition security

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Why is nutritional assessment important?

• Helps identify geographic locations most in need of development projects

• Useful input into project formulation through needs assessment

• For monitoring and evaluation of projects since human welfare impact of the project can be directly measured through nutritional assessment

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Nutritional indicators for needs assessment

Anthropometric indicators Application

1. Proportion of children with haz<-22. Proportion of children with whz<-23. Proportion of adolescents and adults

with low (high) Body Mass Index (BMI)

5. Prevalence of low mid-upper arm circumference (MUAC) in children, 6 - 59 months

Prevalence of stuntingPrevalence of wastingPrevalence of thinness (obesity)

Protein-energy malnutrition, low muscle mass, risk of death

Laboratory indicators

6. Prevalence of low serum retinol in preschool children

7. Prevalence of low hemoglobin in preschool or school-age children

8. Prevalence of low hemoglobin in non-lactating, non-pregnant women

9. Prevalence of low hemoglobin in men

Vitamin A deficiency

Prevalence of anemia

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Different sources of data on nutrition

• Bangladesh National Nutrition Survey• 1962-64, 1975-76, 1981-82, 1995-96• Done by the Institute of Nutrition and Food Science

(INFS) under the University of Dhaka

• Demographic and Health Survey• 1993-94, 1996-97, 1999-2000, 2004, 2007• Done by the National Institute of Population Research

and Training (NIPORT) under the MoHFW

• Child Nutrition Survey• 1985-86, 1989-90, 1992, 1995-96, 2000, 2005• Done by the Bangladesh Bureau of Statistics (BBS)

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Nutrition data sources ………………..cont’d

•Food Security and Nutritional Surveillance Project (FSNSP)

• 2010 in 3 rounds so as to provide seasonal data on maternal care and malnutrition and child care and malnutrition

• Done by Helen Keller International (HKI) in collaboration with BRAC University and BBS

•National Nutrition Program (Baseline Survey)• 2004• Done by ICDDR,B in collaboration with NIPORT and

IPHN

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CNS and BDHS

Child Nutrition Survey

• Nationally representative. Same households as HIES but with at least one child, < 60 months available

• Collects data on nutritional status of children 0-59 months by age, gender, location, season, region etc. Prior to 2005, sample included children 6-71 months.

• Nutrition status can be related to different indicators of household food security

• From 2005, the CNS is re-named as Mother and Child Nutrition Survey

Demographic and Health Survey• Nationally representative. DHS 2004

and 2007 used the 2001 Population Census as the sampling frame.

• Focus is on demographics -fertility, use of family planning methods, infant and child mortality, maternal and child health, HIV/AIDS. On the nutrition front, it collects data on infant feeding and nutritional status of women and children.

• Sample includes children < 60 months, women 10-49 years and men 15-54 years.

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Child nutrition 1995-96: comparing different data sources

Page 14

Modera

te S

tuntin

g

Severe

Stu

nting

Modera

te w

astin

g

Severe

wast

ing

Modera

te u

nderwt

Severe

underw

t

MUAC<12.5

0

5

10

15

20

25

30

35

40

45

31.7 31.3

15.2

2.3

40.4

25.5

12.3

27.525.3

14.7

2.5

40.4

18.9

10.4

2729.2

14.3

3.9

36.5

21.3

INFSBBS DHS


Child nutrition 1999-2000: comparing different data sources

Page 15

Modera

te S

tuntin

g

Severe

Stu

nting

Modera

te w

astin

g

Severe

wast

ing

Modera

te u

nderwt

Severe

underw

t

MUAC<12.5

0

5

10

15

20

25

30

35

40

45

29.8

19

10.6

1.1

38.5

12.6

6.5

26.4

18.3

9.2

1.1

34.8

12.9

32.3

27.4

11.7

2.67

33.1

16.28

9.09

CNS DHS NSP


Child nutrition 2005: comparing different data sources

Page 16

Modera

te S

tuntin

g

Severe

Stu

nting

Modera

te w

astin

g

Severe

wast

ing

Modera

te u

nderwt

Severe

underw

t 0

5

10

15

20

25

30

35

40

45

2726.3

16.7

11.6

1.3

34.7

12.8

30.5

19.6

11.2

0.7

42

13.8

CNS

DHS

NNP (baseline)


Probable reasons for data discrepancy among sources

• Inaccuracy in age reporting due to lack of birth record

• Age group studied• Time of data collection• Definition of location

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Sources of data on food security

• Household Income and Expenditure Survey (HIES)• Done by BBS• 1973-74, 1981-82, 1983-84, 1985-86, 1988-89, 1991-

92, 1995-96, 2000, 2005, 2010• Among others, provides information on:•Household income and expenditure•Daily per capita intake of different food items hh food security•Average calorie and protein intakeOther related data on food security include:• health status• child immunization• pre- and post-natal care• participation in social safety nets• housing, water and sanitation

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Sources of data on food security…….cont’d

• Welfare Monitoring Survey• Conducted for the first time in 2009• Records data on standard of living indicators on non-

income dimension• Asks direct questions on food security

• Food Security and Nutritional Surveillance Project (FSNSP)• Collects food security data on a seasonal basis

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Bangladesh Integrated Household Survey2011-2012

• Nationally representative survey being conducted by IFPRI to yield integrated hh data for policy analyses

• 6500 households; survey completion in April 2012• Detailed information on food security – captures both

hh as well as intra-hh food consumption and also food frequency

• Detailed plot-level data on agriculture• Detailed nutrition module, including anthropometry,

IYCF, micronutrient consumption, exposure to national IYCF communications campaign, use of health and nutrition services

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Anticipated nutrition-related outputs fromBIHS data

• National food and nutrition profile disaggregated by division: gender differentiated analysis

• Status paper on SUN and SPRING interventions• Nationally representative findings on exposure to

national IYCF media campaign• Analytic papers on

• Determinants of use of nutrition-related services• Women’s assets and child nutrition• Household food security and child diets/child nutrition• Agriculture and nutrition linkages

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Different units of analyses

• Food security indicators are mostly collected at the household level or community level

while

• Nutrition indicators are collected for individual and infant-mother pairs

So how do we integrate these two indicators?

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Integrating data on food security and nutrition security

• Food security indicators may be used in conjunction with health and care practice indicators for possible cause of malnutrition

• For e.g. link between income and expenditure (food security indicators) and health (diarrhea) with malnutrition

• Agriculture productivity or homestead food production can be linked with nutrition status

• Diversification of agriculture production can be linked to nutrition status

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Integrating data on food security and nutrition security……cont’d

• Assessment to improve health and nutrition programming may be used to obtain food security related information, particularly on food consumption and infant feeding practices

• Household’s perception of its own food security standing and nutrition status of children in the household

• Household’s energy and protein intake and the nutrition status.

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Best practice to integrate food security and nutrition for program assessment

• Standardized questionnaires and checklists should be used in repeat surveys while nutritional status should continue to be collected at the individual level.

• Food consumption data (24-hour recall, 7-day recall) must complemented with data on market availability and food prices so as to link the availability, access and utilization components more rigorously.

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Needs assessment process for project implementation

1. Collate nutritional data from as many different population-based sources as possible

2. The information should be arranged by indicator, age group studied, and year of collection

3. Conflicting evidence from different sources should be carefully reviewed with the help of local experts to identify the source of the discrepancy.

4. Subsequently, it may be helpful to rank the different problems identified according to their frequency in the population

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Thank you!

Page 27


Health

Nutrition

AgricultureIncome

Employment

Food security

AGRICULTURE BENEFITS NUTRITION + HEALTH THROUGH:

AGRICULTURE POSESRISKS:

Productivity

Physical strength

Endurance

Cognition

Risk taking

Water-related diseasesFood-borne diseases

Zoonotic diseases

Dietary diversity

Livelihoods

AGRICULTURE – NUTRITION - HEALTH

HEALTH & NUTRITIONBENEFITS AGRICULTURE THROUGH:

Gender equity

Education


Social Behavior Change and Communications

All components

Enhancing Nutrition along

the Value Chain

Component 1

Prevention , Control of Ag-

AssociatedDiseases Component 3

BiofortificationComponent 2

Integrated Programs and

PoliciesComponent 4

Health

Nutrition

Agriculture

RESULT: A better nourished, healthier population, esp.mothers and children < 2

Risk of AAD Income and gender equity

Labor productivity

Figure 1. CRP4 Conceptual Framework

Availability, access, intake

of nutritious,

safe foods

Knowledge of nutrition, food safety


Inputs into production

Production

Post-harvest handling/storage, processing

Marketing

Increased availability of, access to, and demand for

NUTRITIOUS BEANS

Example: A Nutrition-Sensitive Value Chain for Beans (Uganda)

Field trials with new varietiesSoil & terrain analysis; trainings

Technologies to losses (insects)Nutrient retention analysis

Testing sequencing + duration ofdifferent processing techniques(nutrient retention, anti-nutrients)

Analysis of main market channels,Drivers of market decisions,Presence of nutrient-enhanced foods

Consumer surveysCooking trainings, Education,Behavior chance communications

Source: Adapted from Mazur et al. 2009. Pulses CRSP

Value Chain Steps Activities to Enhance Nutrition


Conclusions

Agriculture alone will not improve nutrition fast enough We have opportunities and examples of success on

how to bridge the agriculture-nutrition divide We have challenges Our biggest challenge AND opportunity is to work

together - cross-sectorally (how?) We need to do much better at documenting successes

– and failures; we need the evidence for advocacy, to stimulate investments

In Bangladesh we have a momentum, new initiatives, committed government and donors, experienced NGOs, strong research community and partners

Documents

Food Security and Nutritional Indicators for Needs Assessment – Collating Information Firdousi Naher International Food Policy Research Institute T RAINING